High Clozapine level

BeyondtheRainbow · Aug 22, 2023, 05:33 PM

I've been on clozapine for years but it's only been recently that levels were easily obtained. I have been having some issues so I had levels done and they came back very high (600 is the high end of normal and mine was 1376). We've got a plan in place to lower my level. My pdoc thinks I've probably been high for a long time and adjusted to it. I may be feeling a lot better soon.

Has anyone else had this happen?

TheGal · Oct 04, 2023, 07:02 PM

Hello BeyondtheRainbow,

Have you managed to get your numbers down? How did they find the numbers were so high in the first place, was it though a blood test?

How have you been feeling?

I ask b/c I know someone who takes clozapine.

Also, I noticed you take gabapentin... is that for anxiety? I ask b/c I've wanted to try it for anxiety, but I think it is contraindicated with the propranolol I take.

I have severe major depression with psychotic features, high levels of anxiety and some OCD.

BeyondtheRainbow · Oct 05, 2023, 08:14 PM

My level is down to 811.It needs to be below 600. I'm waiting to hear from my pdoc what happens next.

I had a blood test done because I was having hand tremors and some other side effects were increased. I don't know how widely available the test is right now; I think it's a new test or at least easy access to it is new (but I think the test is new). I've been on it 7 years so having things change really stood out.

I'm feeling better although I've had a lot of headaches while lowering my dose. Those have started to decrease the last 2 days but I am assuming I'll have one more decrease so probably some more headaches before this is all over.

I do take gabapentin for anxiety as well as sleep. It is really effective for me and really free of side effects. I can't be on propanolol because I have low blood pressure so I don't know how that compares but I highly recommend gabapentin if it's ever an option.

TheGal · Oct 06, 2023, 04:10 PM

Thank you for responding, BeyondtheRainbow... I have been on the maximum of abilify (30mg, now on 20 mg), but I don't know what my blood serum levels would be. I'll let my friend know about the blood test for clozapine.

Currently, I am without a gp and pdoc.

It's good you took the test and are getting care to reduce your side-effects. I hope everything goes well for you!

As for gabapentin, I would like to try it if ever I get into better shape to reduce my pulse (and also high blood pressure)... I have high-levels of anxiety, and I have thought for awhile now that gabapentin could be helpful.

Thank you for your feedback and all the best to you!!

marcoantonio · Nov 12, 2023, 12:17 AM

HI, Guys !

Do you know which pharmacy has the best generic brand of klonopin (clonazepam)?CVS, Wallgreen's, whoever ? I don't know if I adjusted or whatnot (although I already tested other dosages), but I don't trust these makers from India or China...
TIA !

mikrw33 · Feb 20, 2024, 12:02 PM

Quote:

Originally Posted by BeyondtheRainbow

(...) I can't be on propanolol (...)

Another reason not to take propranolol with clozapine is that they're both extensively metabolized by CYP1A2, and it could cause increased blood levels of clozapine and propranolol.

I hope you've been able to reach a state of equilibrium with your clozapine dosage!

BeyondtheRainbow · Feb 20, 2024, 11:21 PM

Thanks. We're still working on it. I got the good news the other day that my level is down to 625 so just over the limit. Unfortunately I really could use a little more of it right now but before my pdoc is comfortable with that she wants to talk to someone with expertise in it. Which I'm all for. She says she knows what to do generally but needs confirmation that being on a slightly elevated dose long term is ok. I'm hoping it is and we can increase just a bit.

Hopefully my next lab will be either below 600 or at a level that has been cleared.

Tart Cherry Jam · Feb 21, 2024, 12:45 AM

Quote:

Originally Posted by TheGal

Thank you for responding, BeyondtheRainbow... I have been on the maximum of abilify (30mg, now on 20 mg), but I don't know what my blood serum levels would be. I'll let my friend know about the blood test for clozapine.

Currently, I am without a gp and pdoc.

It's good you took the test and are getting care to reduce your side-effects. I hope everything goes well for you!

As for gabapentin, I would like to try it if ever I get into better shape to reduce my pulse (and also high blood pressure)... I have high-levels of anxiety, and I have thought for awhile now that gabapentin could be helpful.

Thank you for your feedback and all the best to you!!

I do not know if this is still relevant to you... I have been on Gabapentin continuously for 6 years and it has not reduced by blood pressure and pulse. I did not know it can have this side effect. I see this one study in rats:

Gabapentin Reduces Blood Pressure and Heart Rate through the Nucleus Tractus Solitarii - PubMed

Note that like @BeyondtheRainbow my blood pressure can be low, so propranalol is not something I can take (my blood pressure once fell to below 80/40 when I tried it and Propranalol was instantly discontinued. I have a note in my medical record saying that I should not receive Propranalol). So I take Gabapentin to ameliorate the extrapyramidal side effect of antipsychotics. It produces no side effects whatsoever. I really like it.

If you are trying to reduce BP and HR, exercise can help with those.

TheGal · Feb 23, 2024, 05:11 AM

Hi @Tart Cherry Jam

Sorry for the confusion.

I take propranolol (to reduce heart rate) and olemesartan (for high blood pressure), and as far as I know you can't take gabapentin when you're on those meds.

Tart Cherry Jam · Feb 23, 2024, 12:02 PM

Quote:

Originally Posted by TheGal

Hi @Tart Cherry Jam

Sorry for the confusion.

I take propranolol (to reduce heart rate) and olemesartan (for high blood pressure), and as far as I know you can't take gabapentin when you're on those meds.

I am very surprised to hear that. My pdoc in particular said that gabapentin is unique in not interacting with other meds. I have checked both of your drugs for interactions with gabapentin on WebMD and found none:

Benicar and gabapentin Interactions - Drugs.com

Drug Interaction Report: gabapentin, propranolol

TheGal · Feb 23, 2024, 06:20 PM

Quote:

Originally Posted by Tart Cherry Jam

I am very surprised to hear that. My pdoc in particular said that gabapentin is unique in not interacting with other meds. I have checked both of your drugs for interactions with gabapentin on WebMD and found none:

Benicar and gabapentin Interactions - Drugs.com

Drug Interaction Report: gabapentin, propranolol

Thank you for checking that out! Maybe it's another med I'm on, or I got my wires crossed.

I will check that out with the pharmacist.

Only problem now is my doc closed her practice, so I've been going to walk-in clinincs, so I rather doubt a doc who doesn't know me will prescribe it. I already take 8 meds...

But, I've always felt that gabapentin would help with my anxiety and from there I could reduce some of my antidepressants.

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